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Prescribing physical activity as an alternative way of treating physical and mental health problems: interview with Marita Friberg

To support EU
Member States in reaching the Sustainable Developmental Goals, the European
Commission has established the new expert group “Steering Group on Health
Promotion, Disease Prevention and Management of Non-Communicable Diseases”. The
Group sets Public Health priorities and coordinates implementation of
evidence-based best practice interventions in other countries. We conducted an
interview with Marita Friberg from the Public Health Agency of Sweden, who presented
a best practice example on prescribing physical activity for physical and
mental health problems, which planned to be implemented in 10 other member
states.

PB: Thank you, Marita, for agreeing to participate in this interview. Could you please give us a short summary of your best practice example on prescribing physical activity? How did your project become part the best practice examples?

MF: Our project was
suggested by the Steering Group as a best practice example. We developed a
method in Sweden (prescribing physical
activity), which has been scientifically evaluated and is proven to be as
good as medical treatment (to address
physical and mental health problems). Prescribing physical activity is used
in healthcare, and follows the medical treatment process: the prescriber has to
be registered, the process has to be followed-up and documented in a systematic
way. The prescriber could be a doctor, a nurse or a physiotherapist. These are
the key figures of the method. The evidence-based handbook presents
prescriptions for different diagnoses. The treatment is individualised,
happening in a dialog with the patient and based on each person’s capacity and
motivation.

GB:What can you do if people do not want or cannot afford to buy a membership for a sports facility?

MF: The recommendations in the guidebook only indicate the dosage, not a particular activity. For example, strength-training three times a week or aerobic training four times a week. Then, in dialog with the patient, we discuss what is most convenient, and we try to find the physical activity which suits the person the best. The dialogue is central and essential to the implementation of the best practice. If the cost for gym is too expensive, then you can find other options, such as using your own bodyweight or working out at home. We talk about how you can integrate physical activity in your everyday life. For example, if you are going to your workplace or visit friends, walking, getting off the bus earlier or cycling, all of those would be an option to increase physical activity. Or taking the stairs instead of the elevator. The majority of patients receive prescribed walking. It is not about the exercise itself, it is about physical activity.

PB: …but what if I don’t want to do it alone?

MF: Then the healthcare can inform you of physical activity providers and groups in your area. In some regions, there are even health coaches. If you visit your doctor, she/he can recommend you talk with a health coach, who is usually a trainer or physiotherapist, and the coach can help you further.

PB:In Belgium, GPs have more or less 15 minutes to see a patient. How can this dialogue fit in such a short timeframe?

This is also a
problem in most of the countries we have been talking to, because only the
doctors are allowed to prescribe. In Sweden, we are using special trained
nurses, because doctors often have limited time for a dialogue. It is cost-effective to use nurses. However,
it is important to have doctors on board because they meet the patient and they
can suggest the patient to talk to the nurses. Doctors can be the door openers,
but they do not have to be the person who has the dialog with the patients.

GB: What is your experience about working with people from lower socioeconomic background? Studies show a social gradient in physical activity.

MF: This is an important issue we have to work on. Also, the adherence to the prescription. We are struggling in Sweden, because prescription for physical activity is an offer that patients can accept or decline. This group more often declines the prescription for physical activity and prefers taking medication. We have to include them somehow, otherwise only those who are motivated will participate in our project. This will increase the inequality gap. So, this it is a future lesson to learn, how can we work with these vulnerable groups.

PB: What do you think would be the struggle to share and implement this project in other countries? The healthcare systems might be completely different.

MF: That is why we need a feasibility study at the beginning of the project. We try to be realistic: it is not going to be implemented on national level. We start small. We will work with actual health professionals on local level, who talk to patients and who want to implement our project. Parallel on the structural level, we need to raise awareness in stakeholder workshops, and show how our method could be integrated in the health care system.

PB: What should be the role of the Steering Group on Prevention and Promotion?

MF: I think the Steering Group has started this project, as they see how important it is. We have 10 participating member states at the moment and about 5-6, who want to join. But, we have a limited budget and limited time. We can start the European implementation in this first project, but the Steering Group has to acknowledge that it will need further support, as you are not going to solve this problem with a three years project. While we start with these 10 participating countries, other countries might see the benefits and would like to join. It is important that we can introduce this method to them as well.

PB and GB: Thank you for your
time. We really look forward at seeing how this project will be implemented.

This interview was conducted by Young Gasteiners Petronille Bogaert and Gerg? Baranyi